May 5, 2020
Dr. Lisa Golding, a Mt. Auburn Hospital physician and Harvard Medical School instructor, shares key steps on how to help minimize your and your family’s risk of contracting COVID-19. For more information go to cdc.gov.
The opinions expressed in this podcast are as of the date issued and subject to change at any time. The views of the interviewee are her own may not reflect those of Fiduciary Trust. The purpose of this podcast is for informational and educational purposes only and not for the purpose of rendering medical advice. Listeners should consult their own medical providers for medical advice.
Todd Eckler: Given the health concerns about the novel coronavirus among our clients, friends, and colleagues, today we’re going to discuss ways to help you stay healthy, both in an environment where you may be relatively isolated, as well as one when businesses are more open. I’m Todd Eckler, Chief Marketing Officer at Fiduciary Trust, and I’m joined by Dr. Lisa Golding, a primary care physician at Mount Auburn Hospital in Cambridge, Massachusetts, and an instructor at Harvard Medical School. She also happens to be the wife of one of my colleagues at Fiduciary Trust. Today we’re going to discuss how contagious coronavirus really is and how it can be transmitted; practical guidance and details people often miss around how to create, safely wear, and remove a mask; how the level of social distancing should vary based on the situation; ways to minimize risk exposure when returning to work; and what to do if you’re experiencing COVID-19 symptoms. So let’s get started. First of all, thank you for joining today, Dr. Golding. To learn how best to avoid contracting COVID-19, it’s helpful to understand how coronavirus is transmitted. Could you explain how transmission occurs?
Dr. Lisa Golding: Sure. So the primary transmission of COVID-19 is through respiratory droplets. These are small secretions that are expelled when one coughs or sneezes primarily, and these fall into the air and fall around the environment near a person who is infected.
Todd Eckler: So it’s mainly through the air that people contract coronavirus. What about people touching surfaces that have been infected?
Dr. Lisa Golding: So those respiratory droplets can land on surfaces, and there is some concern about transmission from infected surfaces that requires that somebody touches those surfaces and then touches their face, touches their mouth or eyes or nose, and then the virus can enter that way as well.
Todd Eckler: So I guess that’s why there’s so much discussion about masks, is to keep those droplets from getting out in the environment?
Dr. Lisa Golding: Right. So the primary purpose of masks in the general public, so outside of healthcare spaces, is too prevent those respiratory droplets from spreading from individuals. While they’re primarily spread with coughing and sneezing, some, to a lesser degree, they can be spread with forceful talking, for example, and so masks can contain that. It also may provide some level of protection to someone who’s not infected if it keeps them from touching their mouth and nose in the public space.
Todd Eckler: That’s a good point. There’s a lot of talk about masks, and certainly I see a lot of people in public wearing them. Some cities or maybe even states are mandating the use of masks and I think it’s important to understand how properly to use a mask and what materials to use, how do you make sure that you don’t contaminate things that are touched by your mask. Could you tell us more about this front?
Dr. Lisa Golding: Yes. What is now being recommended is some type of face covering. This can be a mask, bandana, or scarf made from a cloth material. What is most effective is a hundred percent cotton or some other tightly woven fabric, and this can be layered to increase the protection it provides. The mask should cover your nose and mouth and come down below the chin and fit your face snuggly so there are not gaps on either side for air to flow through.
Todd Eckler: So what about touching a mask? Is that a concern?
Dr. Lisa Golding: It’s also important not to touch the mask while you are wearing it. That’s very important. If you do touch it while you’ve been wearing it, you should wash your hands. When you take the mask off, you should try to take it off by the either elastic or whatever it is holding the mask on around the ears and not touch the part that has been over your face. The advantage of cloth masks that people are using, they can be washed. So if you’ve been wearing it out in public, it’s best then to wash it and hot water in the washing machine to clean it before using it again.
Todd Eckler: So when you take off a mask, you just touch it by the straps that are holding it on. So I understand that. What about when you put it down? Do you have to be careful where you put it so you don’t contaminate things, and what are some best practices there?
Dr. Lisa Golding: Right. So if you’re in a situation where you need to put it back on in that same time period, you should lay it on a clean surface. So if you’re out in public, you should not be taking it off. So you really should keep it on during that whole time until you are home or into your car where you could take it off and put it on a clean surface. If you’re not going to be putting it back on immediately, then it doesn’t really matter. It should be then cleaned before using it again.
Todd Eckler: Well thanks for sharing all those thoughts about masks. I think we’re going to be wearing masks for a while, and it’s useful to have that guidance. Another thing that’s an important part of the environment we’re in now is social distancing, and there are some common things around staying six feet away from people and that sort of thing, but I can imagine that there are differences—depending on where you are, what the environment is around you, whether someone’s exercising—that might require different social distancing inside versus outside. Could you go through some of the things to think about in social distancing?
Dr. Lisa Golding: Sure. So the six foot rule that everyone is familiar with by now really applies to indoor spaces. So where there is not a lot of air movement, for example, and people are relatively still, for example, sitting in a meeting or standing in a line. However, when you start to talk about other situations where there’s more activity, where people are exercising, people are out running and biking, then we do need to take into consideration that six feet may not be adequate and that a greater distance is needed, although we don’t really know at this time point exactly how far that is, and these are situations where masks in addition to social distancing may play a role as we get back to more activities in life outside the home.
Todd Eckler: So what about elevators? I mean I can imagine that if you’re on the second floor of a building you might be able to take the stairs, although there too, you could encounter people in the stairwell at close quarters. The elevator itself, those are pretty small quarters. Is that something that you should be concerned about and are there extra precautions you can take if you’re in an elevator?
Dr. Lisa Golding: Yeah, elevators are a concern because it’s such a small space. My recommendation for people who live either in apartment buildings or who might be going to work in a building where they have to use the elevator in that situation, wearing a mask is a good step because you may not be able to control that circumstance. So another reason why masks are being recommended more now is to take into account that we can’t always control social distancing. So as an extra precaution in situations like that, a mask is important. A brief exposure to somebody, a few minutes, may be less worrisome than a situation where you spent a more extended period of time with a person, such as a face-to-face meeting or at someone’s house who then turns out to have been infected.
Todd Eckler: The discussion about elevators brings up the point about touching things. In an elevator, you’re touching the buttons, and that raises the question of sanitizing your hands. Are there some mistakes people can make in the way that they wash or sanitize their hands? And also gloves, is it important to wear gloves? Is that a bad idea? Could you give us some guidance on that front?
Dr. Lisa Golding: Sure. So hand washing is tremendously important. It really is the foundation of preventing spread of COVID infection as well as so other infections, as we’ve known for a long time. For hand washing to be adequate, it is recommended that you wash your hands for at least 20 seconds using soap and water. The idea there is that soap does help to clean off particles, dirt, as well as the bacteria and viruses, to a greater degree than just water alone. Scrubbing your hands is important as you wash them. That also helps remove additional particles and potentially the virus, and then rinsing finally to remove everything. And you want to make sure that you’re scrubbing both the palms and backs of your hands and thumbs. People sometimes forget that.
Todd Eckler: Got to get those thumbs.
Dr. Lisa Golding: So that you are really covering all the surfaces. Gloves may add an extra layer of protection if you’re going to a grocery store or out in public, but you need to be careful that you still are taking the proper precautions, because if you touch a surface and then go ahead and touch your face, for example while you’re wearing the gloves, then you still are at risk for infection. So if you’re wearing gloves you need to be sure not to touch your face. When you remove the gloves, you need to either dispose of them, or if they are reusable, then they need to be cleaned, and you still need to wash your hands after removing the gloves. That’s very important.
Todd Eckler: One of the areas of concern I hear from people is touching their mail or touching grocery bags or groceries themselves. Is that a place where you can get exposure to coronavirus, and is that something people should be concerned about or take action on?
Dr. Lisa Golding: Yeah. A lot of people have concerns about this. The thinking at this point is that that is not a major risk for contagion, and that we don’t think that transmission is occurring that way, but because surfaces can have virus on them and become contaminated, there is a small risk that you might touch something that has virus on it and then you then touch your face, that it could be transmitted that way. So while this is a possibility, it’s not thought to play a major role in how people are getting sick at this point.
Todd Eckler: So we’ve talked about ways to minimize exposure through sanitizing your hands, but there’s not so much of a concern around mail and bringing things in, although you could just err on the side of safety. What about keeping your house clean and disinfected? What are some of the key tips on that front?
Dr. Lisa Golding: Yeah, so because it can live on surfaces and we don’t know how long it can remain infectious on those surfaces, cleaning the house regularly, focusing on surfaces that people touch frequently. So this includes doorknobs, handles, countertops, and surfaces in the bathroom. These are areas that you really want to focus on cleaning, and if you have people in and out of the house, particularly who may be going out to work and coming back in, who could potentially get infected, you do want to clean these surfaces regularly to prevent potential transmission within the house.
Todd Eckler: We’ve talked about a number of ways to avoid exposure to coronavirus. I wanted to switch gears now and talk about people who actually have coronavirus. So my understanding is that people can sometimes not exhibit any symptoms when they have the coronavirus, but when they are symptomatic, what are some of the symptoms that manifest themselves?
Dr. Lisa Golding: Sure. So the incubation period for coronavirus is from two to 14 days. So that means that from the time of exposure, an individual can become sick and show symptoms as early as two days and as long as two weeks. However, on average, most people will show symptoms after five to six days of being exposed if they are going to get sick, and by 12 days the vast majority, about 97% of people will show symptoms if they are going to become ill. However, some people we know don’t show any symptoms of coronavirus and may not get any symptoms at any point. However, they can still be contagious and are a part of the reason it’s been difficult to control the spread of infection.
Once people do become ill, the most common symptoms include fever, chills, body aches, congestion, cough, shortness of breath, chest pain, or chest tightness. So these are primarily respiratory symptoms. However, we know that other symptoms are also associated with coronavirus, and this includes nausea, vomiting, and diarrhea as well. These can often be early symptoms of the infection before someone has the respiratory symptoms. So it’s important if you’re having any of those symptoms to think about this as possible COVID infection. Other symptoms that are important to be aware of and have become clearly recognized are a loss of taste or smell. While this is not that common, it is a very specific symptom, an unusual symptom, and highly suspicious for coronavirus infection.
Todd Eckler: This is certainly a challenging illness given that some people don’t even exhibit symptoms. If you are exhibiting some of the symptoms you just described, what should you do?
Dr. Lisa Golding: So the best thing to do if you have any symptoms concerning for coronavirus is to contact your physician. They will most likely do a telehealth visit with you to discuss your symptoms and give you guidance on next steps such as treatment or care. If you don’t have a physician to reach out to, there are many urgent care centers throughout the community where you can get assistance. The best way is to call them and they will discuss your symptoms with you, and if testing is indicated, they will give you an appointment time to come to their center to be tested. They do not want people showing up to the testing sites without a pre-visit screening. This is very important, and this screening happens over the phone. If you can’t reach out to your physician to get guidance on where to go for testing, you can find resources online through the state of Massachusetts. For example, there is a listing of test sites with phone numbers to call for additional information and screening.
Todd Eckler: Well that’s good to know you shouldn’t just show up at a testing center. So over time as more businesses open and people go back to work, what are some of the precautions you should take in being in public places, restaurants, and places of work?
Dr. Lisa Golding: Yeah, I think continuing to practice the things that we’ve been talking about here outside the home, just as you’ve been trying to do, continuing with good hand hygiene. Wearing masks, I think, will be a big part of how we try to protect the public as they return to more regular activities, and this may even be required in certain places where social distancing cannot be adequately practiced. Masks are really not in place of social distancing and that’s important to remember. So as we start to go out to places, you still want to practice social distancing and keep the six feet distance in mind as best that you can. Again, since that’s not always possible, that’s where masks come into play, as well as trying to prevent individuals who are asymptomatic from spreading infection, but it will continue to be really important that if you do you have any symptoms that you stay home. That’s going to be a critical part of trying to contain this, even as some of the restrictions loosen.
Todd Eckler: Yeah, it’s going to be tricky going back to more of an open environment with obviously some restrictions. I know people have been cooped up for such a long period of time. They’re going to be eager to get together with friends and go out and do things, but it’s going to be so important to continue to wear masks and do the cleansing, the distancing, and all of that, and it’ll just be important that people keep that vigilance up.
Dr. Lisa Golding: It will change our environments. When people return to work, they’re going to have to rethink how people sit and interact indoors, limiting numbers of people in at a given time, really taking steps to reduce the number of people in a space to prevent exposing multiple individuals, potentially, at a given time to someone who may be asymptomatic and have no idea that they are infected.
Todd Eckler: Well we’ve covered a lot of ground today and I really appreciate your being with us today, Dr. Golding. I hope our listeners found it useful and I would say if they’re looking for additional resources, the website for the Centers for Disease Control is a great source at cdc.gov, and also state health sites, and clearly your medical providers are an excellent source of information. If you have questions that Fiduciary Trust can help with, non-medical-related questions, please reach out to your Fiduciary Trust officer, or if you don’t have one, you can reach out to Rick Tyson at (617) 292-6799 or firstname.lastname@example.org. Thanks for joining today and stay safe and healthy.